The many roles of family members in "family-centered care"--part II. Interview by Deborah Dokken

This article highlights the role parents can play as advocates for their own children. A mother who is interviewed describes a nurse's support in helping her claim her baby as her own in the midst of the NICU environment and how that claiming led her to become involved in his care and a strong advocate for his needs. She shares advice for parents and health care providers. A physician who is interviewed discusses working with this mother and other parents, and describes ways health care professionals can support parents as advocates.     

The many roles of families in family-centered care--part VI

The mother of a child with cystic fibrosis describes her journey from sorrow and fear to hope. Her journey to hope began as partnership with a knowledgeable pediatrician and cystic fibrosis team. The journey wound through demanding care requirements, anguishing questions, and new realizations. The support of friends, and immersion in information about the disease, were also empowering. An introduction to the Cystic Fibrosis Foundation led this mother to volunteering, then to serving on a chapter Board of Directors, and finally to employment by the Foundation as a fundraiser. Both parents and health care organizations benefit from such arrangements. As this author states: "Working with the Cystic Fibrosis Foundation gives me a 'big picture' view of the state of my daughter's disease, and a sense of contributing a small part to the product of its big mission to cure and control CF, and [gives me] hope."     

The many roles of families in family-centered care--Part III

Lawrie Williams, a mother of two daughters who have experienced serious medical challenges, authors the third in a series on parental roles in family-centered care. This article highlights the role parents can play in helping other families through parent-to-parent support programs. Lawrie first experienced the support of another parent when one of her daughters was young, and later realized she could use her own experiences professionally. For the past 6 years, Lawrie Williams has been the coordinator of the Parent Support Program at the Center for Children with Special Needs, Children's Hospital & Regional Medical Center in Seattle, Washington.     

The many roles of families in "family-centered care"--part IV

A parent whose premature twins were cared for at Children's Hospitals and Clinics of Minnesota describes giving back to the hospital as a member of the Hospital's Family Advisory Council. Members of the Council play a range of roles in the hospital. Family Advisory Council members assist the administration in developing, implementing and evaluating the services and the facilities of the hospital system and have input into hospital policies and initiatives. Members also educate hospital leadership, staff, managers, students, and new employees through orientations and in-service training addressing the needs of families and how care can be improved. Family Advisory Council members interact with other patients and families by fielding concerns and suggestions. Children's Hospitals and Clinics of Minnesota have a strong commitment to involving family members as advisors in every aspect of health care and on every level of the hospital system that impacts children and their families.     

A lifeline for families. Interview by Carol Davis

Eating disorders are becoming more common among younger children, including boys. Nurses in specialist units offer a lifeline.     

The many roles of cytochrome b5

Four distinct suggestions have been made to explain the mechanism of the cytochrome b(5)-imposed positive modifier action of the cytochrome P450 monooxygenase reaction. The first mechanism involves a direct input of an electron into the monooxygenase cycle. This is the second of the two electrons necessary for activation of molecular oxygen, and appears to be a rate-limiting step in the monooxygenase reaction. P450 monooxygenases all appear to be uncoupled to varying extents, releasing superoxide and hydrogen peroxide instead of oxidized substrate. A second mechanism suggests that cytochrome b(5) acts as a positive modifier of the monooxygenase by decreasing the extent of uncoupling of the monooxygenase reaction. The implication is that a slow input of the second electron allows uncoupling of a superoxide anion instead of formation of two-electron reduced oxygen. Faster input of the second electron via cytochrome b(5) would result in formation of more of the activated oxygen that reacts with substrate to form product. A third suggestion involves formation of a two-hemoprotein complex between cytochrome b(5) and cytochrome P450 that allows acceptance of two electrons from NADPH-cytochrome P450 reductase. Uncomplexed cytochrome P450 accepts an electron from the reductase, dissociates from it, binds oxygen, and re-associates with the reductase to accept another electron. Complexation with cytochrome b(5) enhances the rate of formation of the active oxygen by obviating the need for two interactions with reductase. The fourth mechanism has cytochrome b(5) serving as an effector without a reduction-oxidation role in the monooxygenation reaction. This effector function may be to enhance the breakdown of the oxygenated hemoprotein to products or to facilitate flow of electrons through the system.